Tuesday, March 28, 2017

Stop asking me 'How Are You Feeling?'

Ever since I had brain surgery last November and subsequently diagnosed with Glioblastoma and started giving regular updates about the ordeal, many people have been pissing me off by asking me 'How are you feeling?'. I have been totally ignoring them so far (easy to do when the communication is online, difficult when in person), and writing this blogpost to educate everyone about why it is not a good question to ask me.

'How are you feeling?' is a perfectly normal question - a very polite and appropriate one - to ask a person undergoing a normal illness like a fever or something similar. However, it is a stupid question to ask someone in my situation. 

I don't have a fever that has made me sick right now and from which I will recover from in a couple of days and everything will be hunky-dory again. 

What I have is a Death Sentence. A Cancer without a Permanent Cure as of now. 

I am perfectly healthy now, and have been so since recovering from the surgery 2-3 weeks after the surgery. When the tumor does strike again - in a year or two or in 10 years, I won't have time for 'how am I feeling' nonsense; I will be throwing up and losing consciousness on my way to the ER/Hospital for a surgery. Or Dead.


I haven't looked at the gory details of how Glioblastoma kills a person, but I imagine it will be quick and decisive when it happens. 


I am sharing about my experiences with this disease with the hope that it helps/inspires others, and with the hope that it helps me in my ongoing fight with Cancer. Stop annoying me with stupid questions.

Thursday, January 12, 2017

My medical insurance story

Earlier this week, Accredo Specialty Pharmacy informed me that the next batch of my chemotherapy tablet (Temozolomide) prescription is ready, and it has a ~$4,500 co-pay that I have to pay. 

It came as a bit of surprise since the first two batches were fully paid for by Anthem Blue Cross Blue Shield - the medical insurance I have been on since 2016 through the Obamacare Marketplace Exchange. Since this is the start of a new year, the copays and deductibles reset and I have to pay the maximum-out-of-pocket amount ($6,500) before the insurance company starts paying for all the expenses. 

So it is not a big deal that I have to pay ~$4,500 for the next batch of my chemo therapy tablets. Instead of paying out the out-of-pocket-maximum amount through the year like I did in 2016, I will be paying a big chunk of it at the beginning of the year. The insurance company will pay for all the expenses beyond $6,500. 

The fact that I had good medical insurance last year made my ordeal with Brain Surgery in November go smoothly. To recap the ordeal very quickly:
  • After a perfectly healthy life with no serious medical issues for 44+ years, and with no major symptoms to herald a severe health issue, I start having a strong bout of nausea, vomiting, and disorientation the morning of Sunday November 13th. 
  • The nausea and disorientation get worse through the day and that night. I lose consciousness around 5AM the next morning (Monday November 14th); that's the final straw and I am taken to the Longmont United Hospital by emergency services.
  • The duty doctor examines me in the morning, suspects a brain issue, and orders CT Scans/MRI scans to further investigate. The scans confirm there is a big mass on the top-right-side of my brain. This is at around 8:30AM of Monday November 14th.
  • The machinery kicks into action; right people get involved; a surgery to remove the brain tumor is scheduled for that afternoon.
  • The surgery starts at 2:00pm the same day, goes on for a couple of hours, and is later deemed to be very successful. 
  • I stay at the hospital for 2 more days, and am discharged to go home on Wednesday November 16th.
  • After taking a break of 3 weeks, I am back to work as a freelancer on  Monday 5th December.
  • On Friday December 9th, we meet with the Medical Oncologist to discuss the diagnosis & the prognosis from the surgery. The biopsy on the resected tumor results in a diagnosis of Glioblastoma Multiforme (GBM) - the most aggressive form of Brain Cancer, and one without a cure as of now. The Medical Oncologist prescribes a 6 week Radiation therapy + Chemo therapy treatment plan to start with. This is supposed to be followed with multiple bouts of Chemo therapy treatments over the next 6 months.
  • I start on the 6 week Radiation therapy + Chemo therapy treatment on Tuesday December 20th.
The whole process - from me falling sick, to brain tumor being identified, to surgery, to recuperating  at the hospital for 2 days, to follow up treatment - all of it has gone smoothly mainly because of the financial guarantee provided by the good medical insurance I had. Thanks to the smoothness of the process,  the surgery was without any undesirable side-effects, and I was back to full health very quickly. 
Me on 2nd Dec 2016, after the sutures were removed.

If I did not have good medical insurance, there would have been delays and diversions at each of the above steps to arrange for money to pay at that step before the (medical procedure / next action) could proceed. And such delays and diversions could at worst have led to my death, and at a less worse case, led to the surgery and recovery taking longer or leaving me with some undesirable side-effects.

The premium for my medical insurance in 2016 was $687.55 per month. That is for the three of us (me, my wife, and our 3 year old daughter). I used to think it was expensive. Not anymore. 

The insurance paid nearly $175,000 through my brain surgery ordeal and the follow up treatments. So I would say I have been very fortunate to have had a good medical insurance. I am not really minding the fact that the premium went up to $877.07 per month in 2017.

I am thankful for the Affordable Care Act (Obamacare) for allowing me to have such good medical insurance while I work as a freelancer.

What does the future hold, especially with the ongoing efforts at repealing Obamacare?
No idea, but for now I am very scared of the possibility of not having adequate medical insurance to cover for my ongoing treatment needs for the next few years. 

I will quite likely need more surgeries, radiation therapy, chemotherapy, immunotherapy, etc. to keep GBM at bay over the next few years. I don't think I will be able to bear the costly expenses for these procedures all by myself. Getting help from family, friends, and strangers through a GoFundMe campaign is an option, but the expenses are quite likely to be beyond the reach of the goodness of people. 

If the repeal of Obamacare comes about and results in me not having affordable medical insurance, the ongoing cancer care I need is likely to be out of my reach. 

Obamacare repeal could literally be the death of me. 🙁




Friday, December 20, 2013

How I got very good at Public Speaking

From IgniteBoulder16 - Everything you need to know about cricket - Prakash Murthy

Not too long ago, I used to dread any situation that involved me being on stage and addressing a lot of people. 

One time during my engineering college days, I was asked to say a few words while accepting a prize I had won in some competition; I went up on the stage, blurted out "Thank You" and made my escape very quickly! 

I went through an entire 2 years MBA course avoiding speaking up in any group discussion exercises or making presentations. Safety First was the mantra which was driving such "risk-avoidance" behavior. :-) The one time everyone in the class had to make a presentation in front of the class, I hated it with all my heart.

When it was my turn, I spoke at break-neck speed without pausing to take a breath. Many of my classmates were imploring me with gestures to slow down. While I was noticing what they were saying, I seemed to have no power to make any changes in my delivery style. Escaping from the spotlight was of the utmost importance, and I had to get away from there ASAP!

Here is one feedback I got after my talk at RubyConf India earlier this year

As the feedback testifies, I am no longer the same person I described at the beginning of this post. These days, I enjoy being on stage! I am very comfortable being up there and engaging a large audience in an entertaining manner. The "dread of the stage" which used to be part of my personality for long is no where to be seen!


How does one go from being deathly-scared of public-speaking to becoming someone who welcomes the opportunity to be on stage?

In my case, the answer is very simple.
All credit for my transformation goes to the Introduction Leaders Program (ILP) - a highly-specialized six-month course that I went through in 2008. 


Wow! Really? A six-month course did it for me?



Yup, it did. That statement comes with some qualifiers.

While it is the 6-month ILP course that is most responsible for the transformation, the gains during the course itself were a cumulative effect of the work done over a 2+ year period between 2007 to 2009. During those years, I was very actively involved with the Landmark Education community in New York City. I had completed the pre-requisite courses over a period of 1.5 years before participating in the ILP course. 

Landmark Education Programs and Seminars happen over weekends and on weekday evenings. The  ILP course is structured as a series of classroom and assisting sessions (during weekday evenings & weekends) over the six months period. 

During the 2+ year period mentioned above, I used to spend 2-3 evenings every week and a full weekend once every month or so at the Landmark Education office in New York City, either attending or assisting in one of the seminars/programs. It was a very empowering and nurturing environment to be part of. My quality of life shot up a few notches because I had immersed myself in that space for those 2+ years. Even though I haven't been in a Landmark Seminar / Program since end of 2009, the lessons learned from my association with Landmark Education have been serving me extremely well ever since.

I consider the education I got during those years to be the BEST EDUCATION OF MY LIFE!


How did the ILP course cause such transformation in me? 


The main objective of the course was to train participants in conducting a 3-hour introduction to Landmark Forum - the flagship program of Landmark Education. 

I did the Landmark Forum course in June 2007 and had the experience of walking out of a long dark tunnel and into bright light for the first time in one's life! Given the amazing experience I had in this first brush with Landmark Education, I was excited and very happy to share about it with everyone I could talk with. The ILP course trained me in giving a structured and effective introduction to the Landmark Forum. 

A few months after finishing the course, I realized that the lessons I learned during the course not only made me good at giving an introduction to the Landmark Forum, but had made me a better public speaker as well!


Some lessons I learned from the ILP course.


Below are six lessons that have been ingrained very deeply in my psyche because of my participation in the ILP course. "Deeply ingrained" is the right way to put it as these have become a natural part of me and I don't even make a conscious effort to think about them.


Lesson #1: Aim to inspire action


As Seth Godin puts it very eloquently, Every presentation worth doing has only one purpose: To make a change happen. While leading an introduction to Landmark Forum, my goal was very clear: To make the audience members see a glimpse of the power of the Landmark Forum course, and inspire them to take a step to do the course. It was not making a presentation for presentation's sake.

When I spoke at RubyConf India earlier this year, my goal was to inspire the audience members to devote time for community building activities. The talk was a success as many people have started and continued to do so after being inspired by my talk!

Lesson #2: The most important person during a presentation is not the speaker but the one in the audience


Follows from the first lesson as it is the audience members who are to do something based on what they see/hear in the presentation. 

Looking back at the time I was in ILP course, I realize now that it was this point that I and many of the others had difficulty grasping. Caught up in our own fears and neuroses, we rarely ever focused on the audience member. I think the biggest lesson for me in this context was to learn the ability to get myself out of the way and connect with the audience while presenting in front of them. 


Lesson #3: Practice makes perfect.


During the 6 months of the ILP course, I must have practiced - the full, and parts of - the introduction at least a hundred times - with an audience of 1 to an audience of 50+; with my peers in the course, with the coaches who were volunteering to help us out, with the class leader who was training us, and - toward the later stages of the course - with small groups of complete strangers.

I got better and better with more practice.


Lesson #4: Constant feedback - and follow up corrective action - fuels growth.


A corollary to the previous lesson. Over the six months of the course, I got to perfect myself by taking action on the constant stream of feedback coming at me from my peers and coaches & the class leader at each of the practice sessions. The more I practiced, the more my flaws and inauthenticities were highlighted through others' reflection of what they got from my presentation, and the better I got by getting rid of those flaws/inauthenticities.

End result was I could be myself & very comfortable without my mind going into all sorts of crazy corners while presenting.

Lesson #5: Context is more important than content


The Introduction to Landmark Forum had a standard script which dictated the flow through the 3 hour period. However, it was very clear that one does not have to follow the script by rote to be effective in a presentation. In fact, it is quite likely that the presentation would be a failure if one were to do so.

The context of "being of service to others" built into the Introduction was far more influential in the effectiveness of the presentation than the actual words used during the presentation. 

Lesson #6: Having good Public Speaking skills makes for a better quality of life


This last one is more of a realization I have come to long after completing the ILP course. Previously, given my dread of public speaking, I lived with a motivation to avoid many situations and consequently living a limited life. These days, I go about life less dictated by fear.

Can't emphasize too much how liberating it is to not be bogged down by fears in one's own mind!


Conclusion


If you - the reader - takes only one thing from this post, I hope it is this: 
Public speaking is a learnable skill. There are options out there to enable you to acquire this important life skill. 
The Introduction Leaders Program  - with its very structured approach - did the trick for me. 
Find one that does it for you. 

A post-script for the Indian readers: 

I participated in the ILP and other Landmark Education courses while I was based in New York City. That doesn't mean you have to go to New York or US for attending any of these courses. :-)

Landmark has a big presence in India as well with offices in Bangalore, Mumbai, & Delhi, and courses held in these and many other cities. Many of my family members did the Landmark Forum course in Bangalore.

If you are inspired by my blogpost to do these courses yourself, contact your local Landmark Office!

Tuesday, November 27, 2012

Getting into a Mysore State of Mind

tl;dr : My wife & I will be based in Mysore, India over the next couple of years till both of us can move back to the US. 

I realized in early June that there was a serious miscalculation in our plans of settling in the US; that it would take 2-3 years more before my wife is allowed to come to the US thanks to some ridiculous immigration policies. Wasn't too happy about it; my very first reaction on learning this was "Eff this. I don't need all this trouble; I am going to India!". 

Explored quite a few options over the last few months to deal with this situation; the main ones being:
  • Petitioning to influence the US Congress to change the laws: Nothing much came of it as I wasn't able to gather significant number of signatures for the petition such that it could cause some shift. Also, I gave up on this option after realizing that the issue is really trivial when compared to the other competing issues.
  • Moving to Canada, particularly to Vancouver, for a couple of years: While I was very excited about this option, it became unviable as it turned out that the whole process to get a work visa in Canada would take at least 6 months.
In the end, me moving to India temporarily has emerged as the best option for us. And now that I am getting ready to fly to India this Saturday, I am realizing this option is turning out be a very good thing for us! 

Firstly, I will continue to work as a freelancer for my US based clients while I am in India. Financially, it's a win-win as I will be earning in USD, and spending in INR. :-)

Secondly, since I can work from anywhere, we have the freedom to be based anywhere in India. And we have chosen to be in Mysore, for a variety of reasons, some of the main ones being: (1). It will allow us to be at a distance from both our families in Bangalore. (2). We won't be too far (just a couple of hours away) from our families in Bangalore. (3). Mysore scores over Bangalore by having less traffic & less pollution, and (4). Mysore has a good software industry presence. There are handful of ruby programmers based in Mysore as well! It is quite possible there will be a Mysore Ruby User group soon ;-) "Mysore is a kind of a place which goes to sleep at 9pm". Yup, that is the kind of place I want to be in. 

Thirdly, I will be maintaining a presence in Colorado despite being based in India. I will have a home here as I am continuing to rent my place here in Longmont, and have plans to visit Colorado frequently (once or twice a year) to meet with my clients, and be in touch the Ruby community here. Right now, I have plans to be back in the US in Apr-May of next year, around the time of RailsConf in Portland. Will decide in a few months how long that trip will be for, and about the dates for my next trip to US.

I have also applied for a re-entry permit from USCIS; this will allow me to be outside US for up to 2 years without losing my Green-card status here in the US. 

Very excited about this brand new chapter in our life, about starting our married life for real soon, and about being in India over the next couple of years!

Monday, August 20, 2012

Wikimapia FTW

My 22 mile run from Bangalore to Doddaballapur yesterday had quite a bit of planning going for it.

Initially, I was planning to follow the regular route that we usually take while traveling by bus or motorbike.

Below is the Google Map of the driving directions between Mathikere and Doddaballapur:

View Larger Map

However, one trip on my motorbike along the road a few weeks back convinced me to rule out this route. The heavy traffic along this highway plus the shabby state of the footpath next to the roads (where it existed), and the additional adventure of literally blazing a trail in back country roads made it an easy decision. 

So dug into Google maps a bit more, and came up with the following alternate route:


View Larger Map

However, the problem now was that Google maps did not have names for many of the places/villages along the way, and with the meagre amount of roadsigns in India, it would have been virtually impossible for me to find my way correctly along this route I had decided. Without the name of the next village I had to go to, I ran the risk of being diverted off the route very quickly. 

On one of our road-trips (on motorbike) from Doddaballapur to Bangalore a few days ago, my wife and I tried to follow this route, and were off the intended route within 2 miles of leaving Doddaballapur. Nevertheless, that trip turned out to be very useful as we were able to get the names of a couple of villages on the route closer to my home in Bangalore. 

After that I spent quite a bit of time on the web to find detailed maps of Bangalore Rural District & Doddaballapur Taluk; didn't get anything for a couple of days. Finally, while searching for the map for Shivakote (one of the villages whose name I had identified on our road trip a few days back), I stumbled into wikimapia.org.

Wikimapia turned to be awesomely useful! With a tag-line of "Let's describe the whole world", it is an open-content collaborative mapping project aimed to mark all geographical objects in the world and provide a useful description for them - according to Wikipedia. Thanks to Wikimapia, I learned of the names of all the villages along my chosen route to run, and found lot more useful info about landmarks along the way.
For those interested, the places/villages along the route were Dodda ByalakereShivakote, Linganahalli, Koluvarayanahalli, Seethakempanahalli, Kakolu, Byrapura, Haniyooru, & Gowdahalli. Thanks to the many individuals who marked these places on wikimapia!

Very impressed with the ability wikimapia provides everybody to mark places on the map; I mapped a couple of places in and around our house.

Saturday, January 14, 2012

Terrific gift for anyone with kids in India - Membership at Just Books Clc

I gifted an annual membership "Avid Reader with Magazine Plan" at Just Books Clc to both my sister & brother this week. At Rs. 4,000 ( ~ USD 80 ) for an annual plan allowing for borrowing 4 books & 2 magazines at a time, it is a terrific deal.

I had noticed one of their shops while traveling by bus in Bangalore on my last visit. Their motto - RENT * READ * RETURN - had caught my eye, and made me look up on the internet to find out more about the company.

Found out Just Books Clc has a very good & informative web-site, as well as branches all over Bangalore, including ones conveniently located to both my sister's family and my brother's family. The membership plans too were very attractively priced to sustain my interest further.

Visits to the branches were very pleasant; at both the branches I visited, the staff were very courteous and helpful. Awesome to see the company nurturing a culture of love for reading by emphasizing on employee culture first.

My nieces & nephews (age range 5-9) were thrilled to be at a library with so many books, including ones about their favorite TV show - Chhota Bheem.

I attribute a large part of my success in life to my love of reading; If there is one thing I could give to every kid in my circle, it would be the gift of "love of books".

One thing I love about the United States is the presence of huge public libraries in each and every town. India does not have such libraries which provide easy access to books to the general public. In this context, I think it is fabulous that there are startups like Just Books Clc filling a huge void.

Bangalore based Just Books Clc has branches in a handful of cities in India (Ernakulam, Hyderabad, Kolkata, Mangalore, Mumbai, Mysore & Pune), and plan to grow across the nation. Hope that they succeed in their goal and make books accessible to more and more people.